title: Pre-hospital advanced airway management by anaesthesiologists: is there still room for improvement?
abstract: BACKGROUND
  Endotracheal intubation is an important part of pre-hospital advanced life support that requires training and experience, and should only be performed by specially trained personnel. In Norway, anaesthesiologists serve as Helicopter Emergency Medical Service HEMS physicians. However, little is known about how they themselves evaluate the quality and safety of pre-hospital advanced airway management.
  
  
  METHODS
  Using a semi-structured questionnaire, we interviewed anaesthesiologists working in the three HEMS programs covering Western Norway. We compared answers from specialists and non-specialists as well as full- and part-time HEMS physicians.
  
  
  RESULTS
  Of the 17 available respondents, most (88%) felt that their continuous exposure to intubations was not sufficient. Additional training was mainly acquired through other clinical practice and mannequin- or cadaver-based skills training. Of the respondents, 77% and 35% reported having experienced difficult and failed intubations, respectively. Further, 59% reported knowledge of airway management-related deaths in their HEMS program. Significantly more full- than part-time HEMS physicians had experienced these problems. All respondents had airway back-up equipment in their service, but 29% were not familiar with all the equipment.
  
  
  CONCLUSIONS
  The majority of anaesthesiologists working as HEMS physicians view pre-hospital advanced airway management as a high-risk procedure. Relevant airway management competencies for HEMS physicians in Norway seem to be insufficiently trained and maintained. A better-defined level of competence with better training methods and systems seems warranted.
authors.affiliation: Department of Anaesthesia and Intensive care, Division of Acute Care Medicine, Stavanger University Hospital, Stavanger, Norway. gasman@gmail.com
authors.forename: Stephen J M
authors.initials: SJ
authors.lastname: Sollid
authors.forename: Jon Kenneth
authors.initials: JK
authors.lastname: Heltne
authors.forename: Eldar
authors.initials: E
authors.lastname: Søreide
authors.forename: Hans Morten
authors.initials: HM
authors.lastname: Lossius